War-wounded refugees in Sweden: an eight year follow-up

Refugiados heridos de guerra en Suecia: un seguimiento de ocho años

This paper addresses a longitudinal research program on a culturally heterogeneous group of 61 male refugees in Sweden. They had been injured in war and were referred to the Medical Centre for Refugees, Linköping University Hospital, in the late 1980s, shortly after arrival in Sweden. The subjects were selected consecutively and investigated during hospitalization. They were followed up after two years. Another follow-up was performed in 1997. By then, these men had lived in exile for an average of eight years. Forty-four subjects (72%) participated in this follow-up. The mean age was 34.5 years, SD 7.1 years. Characteristics of the refugees' backgrounds were: obstructed or interrupted schooling and working life; long periods of duty as guerrillas or other political activities (mean 7.0 years, SD 3.8 years); a high frequency of death and separation of family members; a high frequency of imprisonment and torture; and unfavourable conditions prior to the flight. Thus, the group was heavily burdened with respect to risk factors for mental health problems and adjustment difficulties in the host country.

The aim was to investigate physical health, mental health and the social situation after eight years in exile.

Semi-structured interviews, physical examination and mental health questionnaires (Hopkins Symptom Checklist, PostTraumatic Symptom Scale, Well-being scale) were administered.

Among the results we found that 27% were dependent on help from other persons for personal care and/or locomotion after eight years in exile and 73% suffered from chronic pain of considerable intensity. Self-rated psychological well being had not improved during the eight year period. The general mental health status corresponded to findings from previous studies of refugee patient populations. However, only 14% had been seeking treatment for psychiatric reasons. Fifty-two percent were employed, most of them in a sheltered workshop, 23 % were unemployed, 21% participated in an educational program and 5% had a disability pension. Those who were employed had better mental health, according to the measures used, than those who had no employment. Experience of specific pre-migration war traumas were not related to mental health after eight years in exile, i.e. there was no difference between the tortured and nontortured subgroups with respect to mental health measures.

Refugees who have been injured in war have often experienced prolonged and multiple traumatization. They are especially vulnerable persons in exile and they have a long-term need for multidisciplinary rehabilitation and social support.